This blog covers mental health, drugs and psychotherapy with an emphasis on the role of family dysfunction in behavioral problems. It discusses how family systems issues have been denigrated in psychiatry in favor of a disease model for everything by a combination of greedy pharmaceutical and managed care insurance companies, naïve and corrupt experts, twisted science, and desperate parents who want to believe that their children have a brain disease to avoid an overwhelming sense of guilt.

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Tuesday, August 30, 2016

When adult
siblings are continually at one another's throats, the conflicts have often been set
up, either openly or covertly, by the behavior of one or both of the parents
over an extended period of time - usually dating back to the siblings' childhood.Such parental behaviors are particularly effective for this purpose if started when the children were very young and have been continued, with minor variations, throughout their lives.

There are
a number of relatively straightforward techniques for parents to accomplish this goal.

Here are a few common ones; there are undoubtedly a whole lot more.

1. The parent gossips and
complains about each sibling behind that sibling's back to the all the rest of the other
siblings.

2. The parents make constant negative comparisons of one sibling with another. For example, they might repeatedly scream, "Why can't
you be more like your brother?!?"

3. The parent consistantly focuses only on those siblings who are creating repetitive, ongoing problems for themselves - and for
everyone else in the family - and pays no or minimal attention to the siblings who are
doing well and who are functioning independently.

4. Parents may leave
the bulk of their estate to one or two siblings after they pass away, and much less - or even a pittance
- to the rest. This is especially effective if they give almost all the money to
the biggest screw up, or to the ones that did not come over and help take care of them when they were sick or
indisposed in some way.

The picture at the top of the post are musician
Frank Zappa's wife Gail and his two sons, Ahmet and Dweezil. Although there is no way to be certain from news stories orTwitter wars, a recent public
feud in the family might possibly be an example of what I'm talking about.

According the the Los Angeles Times:

"Frank Zappa’s
rich musical and cultural legacy, and which children have a right to profit off
it, have recently become the subject of a public and contentious family battle.
The children of Frank and Gail Zappa – Moon Unit, Dweezil, Ahmet and Diva –
were left unequal shares of the Zappa Family Trust, which owns the rights to a massive trove of music and other
creative output by the songwriter, filmmaker and producer — more than 60 albums
were released during Zappa’s lifetime and 40 posthumously.Thanks to a decision by their mother,
who died in 2015, Ahmet, 42, and his younger sister, Diva, 36, share control of
the trust — to the dismay and anger of their two older siblings, Dweezil, 46,
and Moon, 48, who received smaller portions."

Tuesday, August 16, 2016

In my Psychology Today blogpost of 12/11/11, Bipolar
or Borderline, I described how disease mongering, pill-pushing
psychiatrists have done their utmost best to blur the distinction between the
mood (affective) instability seen in borderline personality disorder (BPD) with
the mood episodes characteristic of
true bipolar disorder. This distinction is important because BPD is clearly a
disorder of interpersonal relationships and behavior mixed in with a history of
trauma and family dysfunction, while true bipolar disorder is a serious
biogenic brain disease. BPD, while some of its symptoms do respond quite well to the right medications,
should be treated primarily with psychotherapy,
while bipolar disorder should be treated primarily with medication.

In the prior post I discussed the use
of invalid symptom checklists in studies to exaggerate the incidence of bipolar
disorder. They are also used by some incompetent psychiatrists to make diagnoses that justify snowing every patient who walks in the door with potentially toxic antipsychotic medication. In the June 2016 issue of the Journal of
Personality Disorders, researcher Mark Zimmerman goes into some detail about
exactly how corrupt researchers use slight of hand to distort their data (Improving the Recognition of Borderline
Personality Disorder in a Bipolar World, pp. 320-335).

They are very good at it. And it
matters. Zimmerman states: "Although BPD is as frequent as (if not more
frequent than) bipolar disorder, as impairing as (if not more impairing than),
and as lethal as (if not more lethal than) bipolar disorder, it has received
less than one tenth [emphasis mine]
the level of funding from the NIH [the National Institutes of Health] and has
been the focus of many fewer publications in the most prestigious psychiatric
journals."

And, Zimmerman points out, the
difference is not due to just the fact that there were more drug studies for
bipolar disorder. In fact, the amount of funding for the drug treatment of
bipolar disorder was just a little more than 10% of the total.

As I have mentioned several times in this blog, self-report symptom checklists are
meant to be screening devises. This means that if you are positive for bipolar disorder
on the screen, it does not mean you have bipolar disorder. It means you should
be evaluated further! Screening tests are designed
to have a lot of false positives - people who come out as positive on the test but who do not actually have the disorder. In fact, the majority of people who screen positively do not have bipolar
disorder.

Zimmerman specifically brings up the
Mood Disorders Questionnaire (MDQ) that I discussed in the previous post. Get
this: in one study by Frye and others in the journal Psychiatric Services in 2005, the authors found that one half of
the patients who were positive for bipolar disorder on the MDQ were not
diagnosed with bipolar disorder by the treating clinician.

Their conclusion? They said the clinicians "failed
to detect" or "misdiagnosed" bipolar disorder in these patients!
Actually, the exact opposite is far more likely: it sounds like the clinicians' judgments
tended to be correct.

Frye and others then went on to state that
these patients were "inappropriately treated because they were given
antidepressants instead of mood stabilizers." Again, exactly the wrong conclusion to
draw from the authors' own data. Yet they went on to say that this completely
false conclusion was "worrisome." Some of us would
call this real chutzpah.

Bipolar, my ass researchers love to
talk about the bipolar "spectrum," based on the crazy logic that if
a given symptom appears slightly similarly in two people, they must both have a version of the same syndromic psychiatric
disorder. Zimmerman asks why no one talks of a borderline spectrum, when
clinically, many patients are diagnosed as having borderline traits. This means that out of the nine criteria, of which you are
required to meet any 5,6,7, 8, or all nine to qualify for the diagnosis, the patients may only have three or four. In fact, as reported in the July issue of the American Journal of Psychiatry (Vol. 173, pp. 688-694), Zanarini and others followed 290 patients with BPD closely over 2 years. They found that "...the symptoms of borderline personality disorder are quite fluid..." This means that they come and go over time. This was particularly true for acute symptoms like self-mutilation. Therefore, people with the disorder may frequently go from 5 symptoms to 4, and suddenly they don't "have" it anymore - unless and until the 5th symptom recurs!In actual reality, he said redundantly, those people who exhibit three or four of the nine symptoms look a lot more like those folks who have five or more than they do like those folks who have none of them. Now that sounds like a "spectrum" to
me.

Tuesday, August 2, 2016

It's a sad fact that mental
health care in the United States is becoming increasingly unattainable.

From 2009 to 2012 the mental
health care industry saw a $5 billion drop in funds across the country,
primarily stemming from national budget cuts. While one in four adults---nearly
62 million individuals--experiences some type of mental illness in a given
year, a staggering 4,500 public psychiatric hospital beds
were eliminated during the same period. New York, Kentucky, California, and
Illinois were among the top cutting states. Additionally, 13 states closed at
least 25 percent of their state hospital beds. Unsurprisingly, this has
resulted in a steep increase in patients visiting emergency rooms across the
country in search of mental health care assistance. States that closed the
highest number of mental health care beds also experienced an increase in
violent crime over the same time period.

Some real life examples may help
to illustrate the serious nature of this ongoing issue:

-A 19 year old from New Hampshire
recently spent 10 days in the common area of a Maine emergency room waiting for
a bed to open in the mental health facility.

-A man who allegedly stole the
equivalent of $5 in snacks died in jail as he waited for space to open up in a
mental health center.

-A woman visited an Illinois
emergency room 750 times over the course of 10 years searching for mental
health assistance. The cost was a sobering $2.5 million.

These are problems that could be
easily eliminated by integrating mental health care professionals into the
emergency room staff of every major hospital.

With examples like this, it is
easy to see why deep budget cuts have negatively impacted the quality of
treatment for those who suffer from chronic mental illness. A recent
heartbreaking report
from the Treatment Advocacy Center found that at least one in four fatal
police encounters involved the death of an individual suffering from a severe
mental illness.

Individuals suffering from
various mental illnesses who do not receive proper treatment often find
themselves in the country's criminal justice system. Aside from the very real
concern that these people will fail to recover without treatment, this also
results in a significantly higher cost to taxpayers and makes for a more
dangerous landscape, both for patients and law enforcement professionals.

While a tragic event can often
increase public attention to mental health needs, the passion is rarely sustained
after the news media cameras stop rolling.

A solution to this healthcare
problem is to staff hospitals with mental health professionals, and find a way
to open additional beds in treatment facilities---places that are specially
trained on how to handle the vast spectrum of mental illness. Until that
occurs, tragedies, much like the gut wrenching 2012 Sandy Hook Elementary
School shooting---that claimed the lives of 20 children and six adults---may
continue to happen. The perpetrator of this specific incident is known to have
suffered from various mental illnesses, and was not able to obtain successful
help.

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About Me

David M. Allen, M.D. is the author of the self-help book, Coping with Critical, Demanding, and Dysfunctional Parents: Powerful Strategies to Help Adult Children Maintain Boundaries and Stay Sane. He is also the author How Dysfunctional Families Spur Mental Disorders: A Balanced Approach to Resolve Problems and Reconcile Relationships. He is Professor Emeritus of Psychiatry and the former Director of Psychiatric Residency Training at the University of Tennessee Health Science Center in Memphis, a position he held for 16 years. Additionally, he has done research into personality disorders and is a psychotherapy theorist. He is the author of three books for psychotherapists: A Family Systems Approach to Individual Psychotherapy, Deciphering Motivation in Psychotherapy, and Psychotherapy with Borderline Patients: an Integrated Approach, as well as numerous journal articles and book chapters. He is a former associate editor of the Journal of Psychotherapy Integration. He received his medical degree from U.C. San Francisco, and his psychiatric residency at the Los Angeles County - University of Southern California Medical Center.